Journal List > J Korean Rheum Assoc > v.17(1) > 1003774

Yun, Kim, Jeong, Lee, Lee, Kim, Na, Yoon, and Lee: A Case of Diffuse Subcutaneous Sarcoidosis Presenting as Thickened Extremities

Abstract

Sarcoidosis is multi-systemic disorder of an unknown etiology, and this is histologically characterized by noncaseating granulomatous inflammation. Sarcoidosis may affect the lung, skin, lymph nodes and eyes, but it rarely affects the subcutaneous tissue. There has been no report of diffuse subcutaneous sarcoidosis in Korea. We experienced a 57-year-old female with diffuse subcutaneous sarcoidosis that presented as thickened extremities. The patient complained of edema and skin thickening on both upper extremities. Magnetic resonance imaging revealed the reticular form of sarcoidosis on the forearm and the biopsy showed noncaseating granuloma. She was finally diagnosed as diffuse subcutaneous sarcoidosis and she improved after treatment with corticosteroid. We report here on this unusual case along with a review of the relevant literature.

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Fig. 1.
The sagittal (A) and axial sections (B) of the Gd-DTPA enhanced T1-weighted magnetic resonance images. These images show the reticular pattern with low to intermediate signal intensity (arrows).
jkra-17-56f1.tif
Fig. 2.
The skin biopsy specimen shows many noncasating granulomas that consisted of epithelial cells, multinucleated giant cells and lymphocytes (H&E stain, ×100).
jkra-17-56f2.tif
Fig. 3.
The sagittal (A) and axial sections (B) of the Gd-DTPA enhanced T1-weighted magnetic resonance images. These images show disappearance of the reticular pattern and the decreased extent of the high signal intensity of the medial subcutaneous fat layer in the left forearm.
jkra-17-56f3.tif
Table 1.
Cases of soft tissue sarcoidosis in Korea
Case numbers Age Sex Lesion Figure Laboratory finding Image finding Treatment Prognosis Reference
1 56 근육 종괴 FVC∗ 74 L (64%), FEV1 1.13 L (56%) FEV1/FVC 65% 근육내 결절형종괴,폐 및 종격동림프절 침범 스테로이드 호전 (9)
2 51 피하조직 종괴 ACE 상승 T2-강조영상에서균등하게 조영되는 피하조직의종괴 수술스테로이드거부 폐침윤 (3)
3 47 반흔 발적 흉부림프절 비대 Topical steroid methotrexate 호전 (7)
4 52 근막 결절 삼두근 근막의종괴, 종격동림프절 비대 NASID§ 호전 (11)
5 39 피부,폐 건선,결절 ACE 상승 폐결절 스테로이드 호전 (14)
6 57 피하폐 사지비후 ACE 정승 피하지방의 망상형조영증가종격동 및 폐실질침윤 스테로이드 호전

∗Forced vital capacity, Forced expiratory volume in one second, Angiotensin-converting enzyme, §Non-steroidal anti-inflammatory drug

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